胃癌急性穿孔的外科治疗(附68例报道)

Surgical treatment for acute ulceration of gastric carcinoma

目的探讨胃癌急性穿孔的外科治疗方法。方法回顾性分析1990年1月-2007年1月对68例胃癌穿孔患者实施的手术方式及其疗效。本组68例患者分为3组,即穿孔修补组(对照组,n=27)、姑息性切除组(n=21)、根治性切除组(n=20)。其中男性60例,女性8例。平均年龄58岁。术前诊断胃癌穿孔30例,疑诊胃癌穿孔25例,误诊为胃溃疡病穿孔13例。所有病例均行手术治疗。穿孔位于胃上部1/3的6例,中部1/3的12例,下部1/3的50例。BorrmannⅡ型38例,Ⅲ型30例。将姑息性切除组、根治性切除组与穿孔修补组术后生存期进行比较。结果本组穿孔修补27例;姑息性切除21例;根治性切除20例,包括根2式胃癌次全切除术(D2)8例,根3式胃癌次全切除术(D3)12例。术后并发症发生率7·4%(5/68),手术死亡率5·9%(4/68)。3组患者术后1、3、5年生存率分别为:穿孔修补组3·7%、0、0;姑息性切除组52·4%、23·8%、0;根治性切除组75·0%、55·0%、10·0%。穿孔修补、姑息性切除、根治性切除术后生存期(月)分别为5·93±4·95、28·33±16·44、35·25±20·36,差异有显著性意义(P<0·01)。结论对于胃癌急性穿孔的病例,采取积极的治疗措施,如姑息性切除或根治性切除术,可望延长患者的生存时间,提高患者的生存质量。

Objective To explore the surgical treatment for acute ulceration of gastric carcinoma.Methods The clinical data of 68 patients with ulceration of gastric carcinoma were analyzed retrospectively.All the cases,60 male patients and 8 females with average age of 58 years,were admitted from Jan.1990 to Jan.2007,and divided into three groups randomly,i.e.repair gastrectomy group（control,n=27）,partial gastrectomy group（n=21） and radical cure group（n=20）.Of the 68 patients,30 cases were diagnosed as ulceration of gastric carcinoma before surgical operation,25 cases were diagnosed as suspected ulceration of gastric carcinoma and 13 cases were misdiagnosed as gastric ulcer.All the cases were undergone operation.The ulcerations located at the superior part（6 cases）,middle part（12 cases） or inferior part（50 cases） of stomach.38 cases were on Borrmann Ⅱ,and the other 30 cases were on Borrmann Ⅲ.The postoperative survival time of the patients in partial and radical gastrectomy groups was compared with that of the patients in repair group.Results Twenty-seven patients underwent repair of ulceration;21 patients received partial gastrectomy and 20 received radical gastrectomy（R2 distal subtotal gastrectomy 8 cases,R3 distal subtotal gastrectomy 12 cases）.Postoperative complication occurred in 7.4% of the total cases and the mortality was 5.9%.One-,3-and 5-year survival rates were 3.7%,0 and 0 in repair gastrectomy group;52.4%,23.8% and 0 in partial gastrectomy group;and 75.0%,55.0% and 10% in radical cure group.Their Survival time were 5.93±4.95 months in repair gastrectomy groups,28.33±16.44 months in partial gastrectomy groups and 35.25±20.36 months in radical cure groups,respectively（P〈0.01）.Conclusion Radical gastrectomy and positive treatment may prolong the survival time and improve the quality of life of the patients with ulceration of gastric carcinoma.